This Week in PLOS Medicine: Insufficient Antimalarial Dosing in Children, Completeness of Trial Reporting, and Increases in Journal Retractions

Antimalarial drug resistance has hampered malaria control programs for almost 60 years. A key factor in combating this threat is to ensure that all antimalarial drugs are deployed in a way that ensures that the maximum number of patients are completely cured. Ric Price and colleagues pool individual patient data from efficacy trials coordinated by the WorldWide Antimalarial Resistance Network (WWARN). The results show that, while treatment of malaria with dihydroartemisinin-piperaquine generally results in excellent patient recovery, young children are at higher risk of treatment failure and this may be due to their receiving an insufficient dose of the drug. The study also highlights that one third of children aged 1–5 years received a dose of piperaquine below that recommended by the World Health Organisation. Furthermore, patients receiving a lower dose were slower to respond to treatment and had a greater risk of getting malaria again. In a linked Perspective, Paul Garner further discusses dosing issues for artemisinin combination therapy.

Agnes Dechartres and colleagues searched ClinicalTrials.gov for completed drug randomized controlled trials that have reported the trial results and then searched for corresponding published studies in PubMed to evaluate timeliness and completeness of reporting. They selected 594 of these trials at random and searched PubMed for corresponding publications. Of the trials, 297 (50%) had no corresponding published article, despite the unpublished trials having a median year of completion of 2009. Some outcomes were significantly more likely to be posted on ClinicalTrials.gov than published in the article or contain more information. The authors acknowledge that unpublished trial results could be published at a future date; some trials may be submitted for publication several years after completion.

In a new Essay that is part of an ongoing series on Research Integrity, Daniele Fanelli examines the evidence and possible reasons for the rising number of retractions. The number of journals issuing retractions has grown dramatically in recent years, but the number of retractions per journal has not increased. The number of queries and allegations made to the US Office of Research Integrity has grown, but the frequency of its findings of misconduct has not increased. Therefore, the rising number of retractions is most likely to be caused by a growing propensity to retract flawed and fraudulent papers, and there is little evidence of an increase in the prevalence of misconduct.